When considering the global problem of cigarette smoking, the leading cause of preventable death in the world, China rises to the top of the list. There are nearly as many smokers in China as there are people in the United States. Each year, Chinese people smoke more than 2 trillion cigarettes, one out of every three cigarettes smoked in the world. It’s also more cigarettes than the next 29 top cigarette-consuming countries combined.
More than 1 million Chinese die each year as a result of their smoking addictions. While Chinese men are 20 times more likely to smoke than Chinese women, this does not mean that Chinese women are spared from the harm of tobacco use in China. A Chinese woman is more likely to die from lung cancer due to chronic exposure to secondhand smoke from her husband’s smoking even if she does not smoke.
Why is the cigarette situation so dire in China?
The answer is without a doubt complex, but in many ways, it comes down to money. China grows 43 percent of all tobacco in the world and has tripled its production over the last few decades. Not only is China the greatest producer of tobacco leaves, but it also manufactures, markets and sells cigarettes through a government-owned monopoly – the Chinese National Tobacco Corp.
As with most countries, the Chinese government secures tobacco tax revenues. The Chinese government is different, however, in that it also receives the profits from the sale of cigarettes. An estimated seven percent of all Chinese government revenue comes from tobacco taxes and profits, making the tobacco monopoly the most profitable of all Chinese state-owned enterprises — even more profitable than the petroleum and the mobile communications monopolies.
Given the economic significance that the Chinese tobacco industry holds, is the hope of reducing smoking rates in China simply a “fool’s errand?” Indeed, it is not. In fact, it is just the opposite.
China is already aware of the public health harm that smoking causes. In fact, many of those 1 million deaths each year occur among working-aged people, weakening the workforce and negatively affecting the Chinese economy. China has also become very concerned about health care costs as it transitions to various universal health care programs. Like the rest of the world, China realizes that it is cheaper to prevent a disease from occurring rather than to treat it after it has developed.
China, like many countries, is faced with a dilemma of balancing short-term revenue and long-term public health benefits. The Central Government has not yet stated a clear course of action, but recent signs suggest that China is beginning to readjust its position from encouraging unfettered smoking to focusing on public health. For example, China has ratified the World Health Organization’s Framework Convention on Tobacco Control, along with 179 other governments.
The central government has also announced plans to pass national legislation that will prohibit indoor smoking and prohibit the marketing and advertisement of tobacco products. Legislation prohibiting indoor smoking has already passed in Beijing with the law taking effect June 1.
Beijing, and cities like it, can more easily implement tobacco-control strategies compared to the central government. The Bill and Melinda Gates Foundation, and recently Pfizer Inc., recognizing the influence and nimbleness of cities, support the work of Georgia State University and Emory University to change social norms regarding smoking, to emphasize the rights of nonsmokers to clean air, and to encourage smokers to quit in 23 cities with a combined population of over 180 million people.
One thing China has clearly demonstrated is its dynamism and ability to change. While the final chapter of this story has not yet been written, there is reason to be confident that, with the right political will and economic strategy, China will soon be viewed as a tobacco-control success story, rather than the currently projected public health catastrophe.
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